Cardiovascular Disease Risk Associated With the Long-term Use of Depot Medroxyprogesterone Acetate

Background: Depot medroxyprogesterone acetate (DMPA) contraception is widely used all over the world; however, it may lead to a decrease in high-density lipoproteins and an increase in low-density lipoproteins (LDL) and triglycerides. These changes in lipid profile have a direct effect on cardiovascular disease risk. This study has been conducted to investigate the relationship between DMPA use and lipid profile, and the effect of worsening of lipid profile on fasting blood glucose. The objective of the present study is to ascertain the effects of DMPA on lipid profiles and Castelli indices, and to estimate the risk of cardiovascular disease in the women using progesterone-only methods for contraception. Methods: This was a multicenter case-control study including females of reproductive age. A total of 893 women were selected according to inclusion and exclusion criteria described below with the age range of 19-49 years. Among these, 477 were females who were beginning DMPA for contraception whereas 416 were the matched controls of same age and socioeconomic status. The lipid profiles, Castelli indices and fasting blood sugar were evaluated before initiation of DMPA and thereafter at 3, 6, 9 and 12 months. Controls were also analyzed for the same parameters in the same manner as that of treated group. The results were analyzed by repeated measure analysis of variance followed by Tukey's post hoc test for the multiple comparisons. Results: The results showed statistically significant differences in all parameters of lipid profile, namely cholesterol (180.7 +/- 38.8 versus 133.03 +/- 14.8 mg/dL, and P = 0.000), LDL (120.04 +/- 36.2 versus 94.27 +/- 19.6 mg/dL, and P = 0.000), very low-density lipoprotein cholesterol (24.6 +/- 10.0 versus 20.99 +/- 8.66 mg/dL, and P = 0.000), high-density lipoprotein (39.67 +/- 3.6 versus 44.13 +/- 4.22 mg/d L, and P = 0.000), total cholesterol (713.05 +/- 110.2 versus 569.19 +/- 80.4 mg/dL, and P = 0.000), triglycerides (126.33 +/- 48.8 versus 99.03 +/- 30.6 mg/dL, and P = 0.000), Castelli index 1 (4.61 +/- 1.2 versus 3.02 +/- 0.31, and P = 0.000) and Castelli index II (3.08 +/- 1.07 versus 2.13 +/- 0.41, and P = 0.000) between treated and control groups, respectively. Serum glucose levels were significantly higher (P <= 0.001) among the cases of DMPA (84.6394 +/- 7.425 mg/dL) compared with that in the control (77.822 +/- 7.733 mg/dL). Conclusions: This study clearly revealed that there is an increase in all deleterious lipid parameters and a decrease in favorable lipid measures. Hence, it can be concluded that continued use of DMPA may predispose females to the risk of cardiovascular disease in the long run.